MEDICARE: DR. KATHLEEN T. SHINE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD.15964	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851373500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN T. SHINE M.D.

Provider Business Mailing Address
First Line	:	101 E 15TH AVE
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3501
Country	:	US
Telephone Number	:	251-949-3479
Fax Number	:	251-949-3434

Provider Business Practice Location Address
First Line	:	101 E 15TH AVE
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-3501
Country	:	US
Telephone Number	:	251-962-1250
Fax Number	:	251-967-7832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	02/07/2023

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